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99054 | MEDICAL SERVICES-UNUSUAL HRS | CPT | Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. |
38211 | Tumor cell deplete of harvst | HCPCS | Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. |
90805 | Psytx off 20-30 min w/e&m | HCPCS | Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. |
38221 | PR DIAGNOSTIC BONE MARROW BIOPSIES | HCPCS | Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. |
99263 | Follow-up inpatient consult | HCPCS | Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. |
99261 | Follow-up inpatient consult | HCPCS | Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. |
99054 | MEDICAL SERVICES-UNUSUAL HRS | CPT | Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. |
38211 | Tumor cell deplete of harvst | HCPCS | Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. |
J8700 | Temozolomide per 5 mg | HCPCS | Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. |
J3490 | ZINC SULFATE 220MG 220MG CP | HCPCS | Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. |
P9010 | WHOLE BLOOD FOR TRANSFUSION | HCPCS | Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. |
J8700 | Temozolomide per 5 mg | HCPCS | Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." |
J3490 | ZINC SULFATE 220MG 220MG CP | HCPCS | Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." |
P9010 | WHOLE BLOOD FOR TRANSFUSION | HCPCS | Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." |
J8700 | Temozolomide per 5 mg | HCPCS | CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. |
J3490 | ZINC SULFATE 220MG 220MG CP | HCPCS | CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. |
P9010 | WHOLE BLOOD FOR TRANSFUSION | HCPCS | CPT procedure codes are level one, and HCPCS are level two. HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. |
J8700 | Temozolomide per 5 mg | HCPCS | HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. ICD-9. |
J3490 | ZINC SULFATE 220MG 220MG CP | HCPCS | HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. ICD-9. |
P9010 | WHOLE BLOOD FOR TRANSFUSION | HCPCS | HCPCS codes are all alphanumeric and include services, products and supplies - such as prosthetics and ambulance services - not covered in the CPT. Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. ICD-9. |
J8700 | Temozolomide per 5 mg | HCPCS | Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. ICD-9. According to the Final Rule, ICD-9 provides coding for diagnosis, procedures and inpatient hospital services. |
J3490 | ZINC SULFATE 220MG 220MG CP | HCPCS | Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. ICD-9. According to the Final Rule, ICD-9 provides coding for diagnosis, procedures and inpatient hospital services. |
P9010 | WHOLE BLOOD FOR TRANSFUSION | HCPCS | Here are several examples of HCPCS codes:
- J8700 = Temozolmide, oral, 5 mg.
- A0030 = Ambulance service, conventional air service, transport, one way
- JO530 = Injection of penicillin
- J3490 = Unclassified drugs
- P9010 = Blood (whole) for transfusion
To meet the standards set by HIPAA (Health Information Portability and Accounting Act), the Final Rule was instituted in 2000. It stated that the CPT and HCPCS codes are defined as procedure codes for "physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services including ambulance." (Source:American Medical Association)
You can learn more about CPT and HCPCS - including how codes are determined and new changes are made - at the American Medical Association's website by clicking here. ICD-9. According to the Final Rule, ICD-9 provides coding for diagnosis, procedures and inpatient hospital services. |
97804 | PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI | HCPCS | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
97803 | Therapy procedure reassessment for nutrition management, each 15 minutes | HCPCS | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
97802 | Therapy procedure for nutrition management, each 15 minutes | HCPCS | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
G0270 | PR MNT SUBS TX FOR CHANGE DX | HCPCS | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
9451 | Injection, peramivir | APC | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
9452 | Inj ceftolozane tazobacta | APC | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
G0271 | PR GROUP MNT 2 OR MORE 30 MINS | HCPCS | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
9449 | Injection, blinatumomab | APC | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
S9449 | Weight mgmt class | HCPCS | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
S9452 | Nutrition class | HCPCS | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
S9451 | Exercise class | HCPCS | The documentation during this session should include nutritional therapy and counseling services provided to manage the condition or disease, and changes to the plan, as needed. Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. |
97804 | PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI | HCPCS | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
97803 | Therapy procedure reassessment for nutrition management, each 15 minutes | HCPCS | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
97802 | Therapy procedure for nutrition management, each 15 minutes | HCPCS | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
G0270 | PR MNT SUBS TX FOR CHANGE DX | HCPCS | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
9451 | Injection, peramivir | APC | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
9452 | Inj ceftolozane tazobacta | APC | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
G0271 | PR GROUP MNT 2 OR MORE 30 MINS | HCPCS | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
9449 | Injection, blinatumomab | APC | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
S9449 | Weight mgmt class | HCPCS | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
S9452 | Nutrition class | HCPCS | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
S9451 | Exercise class | HCPCS | Nutrition therapy codes are time-based: The nutritionist must document the time spent. Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. |
97804 | PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI | HCPCS | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
97803 | Therapy procedure reassessment for nutrition management, each 15 minutes | HCPCS | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
97802 | Therapy procedure for nutrition management, each 15 minutes | HCPCS | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
G0270 | PR MNT SUBS TX FOR CHANGE DX | HCPCS | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
9451 | Injection, peramivir | APC | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
9452 | Inj ceftolozane tazobacta | APC | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
G0271 | PR GROUP MNT 2 OR MORE 30 MINS | HCPCS | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
9449 | Injection, blinatumomab | APC | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
S9449 | Weight mgmt class | HCPCS | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
S9452 | Nutrition class | HCPCS | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
S9451 | Exercise class | HCPCS | Note also that 97802 and 97803 are individual face-to-face assessments, while 97804 is for a group setting. Use HCPCS Level II codes G0270-G0271 to identify a change in diagnosis requiring additional services within the same year of the initial assessment (97802). There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. |
9451 | Injection, peramivir | APC | There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. Latest posts by Guest Contributor (see all)
- I Am AAPC: Mita Shah Morar, PA-C, MBA, CIRCC, CPC, CPMA - September 19, 2018
- VALUE JOURNEY: Design A Roadmap for Success - September 11, 2018
- Pathology Key Words for Correct Coding: Know Their Differences - September 11, 2018 |
9452 | Inj ceftolozane tazobacta | APC | There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. Latest posts by Guest Contributor (see all)
- I Am AAPC: Mita Shah Morar, PA-C, MBA, CIRCC, CPC, CPMA - September 19, 2018
- VALUE JOURNEY: Design A Roadmap for Success - September 11, 2018
- Pathology Key Words for Correct Coding: Know Their Differences - September 11, 2018 |
9449 | Injection, blinatumomab | APC | There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. Latest posts by Guest Contributor (see all)
- I Am AAPC: Mita Shah Morar, PA-C, MBA, CIRCC, CPC, CPMA - September 19, 2018
- VALUE JOURNEY: Design A Roadmap for Success - September 11, 2018
- Pathology Key Words for Correct Coding: Know Their Differences - September 11, 2018 |
S9449 | Weight mgmt class | HCPCS | There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. Latest posts by Guest Contributor (see all)
- I Am AAPC: Mita Shah Morar, PA-C, MBA, CIRCC, CPC, CPMA - September 19, 2018
- VALUE JOURNEY: Design A Roadmap for Success - September 11, 2018
- Pathology Key Words for Correct Coding: Know Their Differences - September 11, 2018 |
S9452 | Nutrition class | HCPCS | There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. Latest posts by Guest Contributor (see all)
- I Am AAPC: Mita Shah Morar, PA-C, MBA, CIRCC, CPC, CPMA - September 19, 2018
- VALUE JOURNEY: Design A Roadmap for Success - September 11, 2018
- Pathology Key Words for Correct Coding: Know Their Differences - September 11, 2018 |
S9451 | Exercise class | HCPCS | There are also HCPCS Level II S codes (not payable under Medicare) to report classes to assist patients:
S9449 Weight management classes, non-physician provider, per session
S9451 Exercise classes, non-physician provider, per session
S9452 Nutrition classes, non-physician provider, per session
Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has more than 25 years’ experience in the medical field. She has worked for both payers and providers, specializing in federally qualified health centers, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif., where she serves as a local chapter officer. Latest posts by Guest Contributor (see all)
- I Am AAPC: Mita Shah Morar, PA-C, MBA, CIRCC, CPC, CPMA - September 19, 2018
- VALUE JOURNEY: Design A Roadmap for Success - September 11, 2018
- Pathology Key Words for Correct Coding: Know Their Differences - September 11, 2018 |
0089T | Actigraphy testing - 3-day | CPT | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY7/21/2005: Approved by Medical Policy Advisory Committee (MPAC)
8/7/2006: Policy reviewed, no changes
9/18/2007: Policy reviewed, no changes
12/24/2008: Coding updated per the 2009 CPT/HCPCS revisions
8/14/2009: Policy reviewed, no changes
04/20/2011: Policy description updated; policy statement unchanged. Added FEP verbiage to the Policy Exceptions section. Removed deleted CPT code 0089T from the Code Reference section. |
0089T | Actigraphy testing - 3-day | CPT | POLICY HISTORY7/21/2005: Approved by Medical Policy Advisory Committee (MPAC)
8/7/2006: Policy reviewed, no changes
9/18/2007: Policy reviewed, no changes
12/24/2008: Coding updated per the 2009 CPT/HCPCS revisions
8/14/2009: Policy reviewed, no changes
04/20/2011: Policy description updated; policy statement unchanged. Added FEP verbiage to the Policy Exceptions section. Removed deleted CPT code 0089T from the Code Reference section. 03/02/2012: Policy reviewed; no changes. 04/17/2013: Policy reviewed; no changes. |
G6015 | Radiation tx delivery imrt | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. |
77386 | HC IMRT COMPLEX | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. |
77385 | HC IMRT SIMPLE | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. |
G6015 | Radiation tx delivery imrt | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
77386 | HC IMRT COMPLEX | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
77385 | HC IMRT SIMPLE | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
G6015 | Radiation tx delivery imrt | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
77386 | HC IMRT COMPLEX | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
77385 | HC IMRT SIMPLE | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
G6015 | Radiation tx delivery imrt | HCPCS | Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.47
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | The Healthcare Common Procedure Coding System (HCPCS) is a two-tiered system that includes Common Procedure Terminology, at Level I, which is usually referred to as CPT codes. More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. For this reason, both medical billers and medical coders need a solid understanding of how these codes are meant to be used, the kind of understanding that can only be gained through a formal education program of study. |
G0358 | IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0360 | Each additional hr 1-8 hrs | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0362 | Each add sequential infusion | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0359 | Chemotherapy IV one hr initi | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0361 | Prolong chemo infuse>8hrs pu | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0357 | IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0356 | HORMONAL ANTINEOPLASTIC | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. |
G0358 | IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged. |
G0360 | Each additional hr 1-8 hrs | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged. |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged. |
G0362 | Each add sequential infusion | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged. |
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